Twin-Twin Transfusion Syndrome

Specialties Ob/Gyn

Published

My dear best friend is pregnant with dichorionic/diamniotic twins. She is 15 weeks. I went with her today for her u/s appt. Baby A is 5 oz, Baby B is 4 oz, with low fluid. She is to follow up with a perinatologist tomorrow afternoon. The OB said he thought it might be that "baby A is getting more nutrition than baby B is, because there may be a blood vessel that is communicating between the placentas." Is this TTTS what he was talking about, and can this occur with di/di twins? I thought it only happened when they shared a placenta. Also worth mentioning: Baby A does not have polyhydramnios, they both have 3 vessel cords, and baby B has both kindneys.

Any thoughts???? Don't have much experience with twins. . .

Up Vote Up Vote ×
Specializes in Maternal - Child Health.

I Googled "twin to twin transfusion syndrome" and found a number of easy to understand articles that all indicated that twin to twin transfusions occur only in identical twins sharing a single placenta. So, I don't think that is what is happening with your friend.

Remember that fetal weights gleaned from U/S are only an estimate, and can vary by as much as 25% from the actual weight, so there may or may not actually be a significant difference in the babies' weights.

The oligohydramnios obviously needs to be investigated, hopefully the perinatologist can shed some light on its cause.

I once

Sorry, hit the send button too soon!

I once cared for a set of twins who were delivered by emergency C-section at 32 weeks due to a diagnosis of twin to twin transfusion and discordant size, made by ultrasound. The perinatologist insisted that the babies were in such danger that there was not time to give Beta-methasone and wait for it to take effect. She was certain that they faced a greater risk from continuing the pregnancy for a few more days than from being electively delivered early.

Upon delivery, they were less than 4 ounces apart in size, not the 1-1/2 pound difference indicated by ultrasound. They were also clearly NOT identical twins, having vastly different appearances, and different blood types. These poor babies and their parents endured long NICU stays and a host of complications as a result of their early delivery, based on a faulty diagnosis.

If your friend has any unanswered questions, please encourage her to get a second or third opinion!

Up Vote Up Vote ×

This early it is hard to tell. Plus there weight may even out more later. I have heard they are cauterizing vessels in utero in cases of TTTS and having good results.

But like Jolie, I'd be more concerned with the oligo.

Good luck to your friend!

Up Vote Up Vote ×
Specializes in Specializes in L/D, newborn, GYN, LTC, Dialysis.

I agree; way too early to tell. It's something they will want to watch closely in the coming weeks. I am so sorry to read of this. If it's truly a case of discordant twinning, the treatments are few and experimental. I hope they can help your friend. Best wishes and please keep us updated, Rae.

Up Vote Up Vote ×

You can have her look up Dr. Anthony Johnson in NC. He is one of the foremost practitioners in this field.

That said, I do agree with another poster that ultrasound weights can be off. She needs to seriously consider all her options and her and the father's thoughts on this issue and the ramifications before making any decision.

Dr. Johnson gets a lot of referrals and does a lot of good work with TTTS, cord coags, etc. From what I've seen he does put a lot of the decision on the parents after presenting the facts, but like any MD, he's also making money off procedures.

The internet is a good resource, but not a end all and be all in facts.

Up Vote Up Vote ×
+ Add a Comment